Volume 27, Number 4—April 2021
Dispatch
Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea
Table
Characteristics | Case 1 | Case 2 | Case 3 |
---|---|---|---|
Age, y |
11 |
11 |
14 |
Sex |
Boy |
Boy |
Girl |
Underlying disease |
None |
None |
None |
Clinical signs and symptoms | |||
Initial symptoms | Fever, abdominal pain | Fever, abdominal pain, headache, nausea, vomiting | Fever, abdominal pain, diarrhea |
Fever | Present | Present | Present |
Conjunctival injection | Present | Present | Present |
Mucosal change | Present | None | Present |
Skin rash | Present | None | Present |
Extremity changes | Present | None | Present |
Lymphadenopathy | None | None | None |
Gastrointestinal symptoms | Present | Present | Present |
Hypotension |
Present |
Present |
Present |
Inflammatory markers (peak) | |||
Leukocyte (neutrophil %), 103/μL | 7.55 (87) | 9.55 (82.8) | 26.56 (93) |
ESR, mm/h | NT | 82 | 77 |
CRP, mg/L | 18.95 | 10.36 | >30 |
Fibrinogen, mg/dL | 633 | NT | NT |
Procalcitonin, ng/mL | 14.55 | 1.54 | 9.62 |
D-dimer, μg/mL | 894 | 2.5 | 3.95 |
Ferritin, μg/mL | NT | 2485 | 663 |
IL-6, pg/mL |
NT |
NT |
2410 |
Abnormal imaging studies | |||
Echocardiography | Coronary dilatation | Mitral regurgitation | Coronary dilatation, left ventricle dysfunction |
Chest radiography or CT | Bilateral pleural effusion, pneumonic infiltration | Suspected pulmonary edema | Bilateral pulmonary edema, pleural effusion |
Abdominal ultrasound or CT |
Abdominal lymphadenopathy |
Mesenteric lymphadenopathy |
Hyperechoic liver, gallbladder hypertrophic edema, peripancreatic fluids, splenomegaly, scant pelvic ascites |
Treatment | |||
IVIg | Provided | Provided | Provided |
ASA | Provided | Provided | Provided |
Steroids | Not provided | Not provided | Provided |
Immunomodulatory | Not provided | Not provided | Provided (Anakinra) |
Inotropic agent | Provided | Not provided | Provided |
ICU care | Provided | Not provided | Provided |
Mechanical ventilator |
Not provided |
Not provided |
Not provided |
Outcome | |||
Hospitalization, d | 12 d | 10 d | 19 d |
ICU admission, d | 6 d | NA | 7 d |
Prognosis | Improved, discharged | Improved, discharged | Improved, discharged |
*MIS-C clinical case definition is as follows: age <19 y, fever >38.0°C for >24 h, laboratory evidence of inflammation (i.e., elevation of ESR, CRP, fibrinogen, procalcitonin, d-dimer, ferritin, LDH, IL-6, neutrophilia, lymphopenia, hypoalbuminemia), multisystem involvement (>2 organ systems involved), severe illness requiring hospitalization, and no other plausible microbial cause of inflammation (i.e., bacterial sepsis, staphylococcal/streptococcal toxic shock syndromes, enteroviral myocarditis). Evidence of SARS-CoV-2 exposure history defined as positive SARS-CoV-2 by RT-PCR, positive serology (neutralizing antibody or anti-SARS-CoV-2 IgG), or exposure to individual with COVID-19 <4 weeks before onset of symptoms (epidemiologic linkage with individual or cluster). ASA, acetylsalicylic acid; COVID-19, coronavirus disease 2; CRP, c-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; ICU, intensive care unit; IL-6, interleukin 6; IVIg, intravenous immunoglobulin; LDH, lactate dehydrogenase; MIS-C, multisystem inflammatory syndrome in children; NA, not applicable; NT, not tested; RT-PCR, reverse transcription PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.